Laserfiche WebLink
ACDH,August 2003 rage—L of <br /> Secondary Containlaft Testing Rep6ii 21 2015 <br /> nisfirm is tntended far use try irzgjecliun stuffpvrfortning tenting during irulallurion of US-T seF <br /> appr'oprktle pages of this form to neport results far all components lo.aed. The conyrlcwd for-m.6=� G olitf franl tests <br /> ,(Voppltcahie),A411 be used in evaluating the installation of new equipment and er j)uir.4 to existing riri�Ar. <br /> 1. FACILITY LNFORNfAT1ON <br /> FacilityName � �ur6r% Date of Test <br /> Facility Address: .� <br /> Fucilky Curuaat: f'honc: <br /> Date Local Agency Was Notified of Testing: 14 . 115 <br /> Name of Local Agency Inspector(present during testing}: <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company U,S,T,Compliance Tcstin Inc. <br /> Technician Conducting Test: Tony Fontana/Bill.McCarthy <br /> Credentials: x CSLB Licensed Contractor SWRCB Licensed Tank Tester <br /> License Type:A Gen.Eng. #846288 License Number: <br /> untr d2r'sMp attfacturcr Training <br /> Manufacturer Com onent s Date—Training Expires <br /> In-Con TS- STS 2-02-2016 <br /> L - <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Paas Fail Not Repairs Component prsa Fail 'Not Repairs <br /> Tested Made Made <br /> d E n n ❑ cl n u <br /> ISS ❑ Cl ❑ ❑ ❑ <br /> ❑ ❑ ❑ �I u ❑ u <br /> ❑ ❑ 11 u 0 ❑ ❑ 11 <br /> ❑ ❑ 1-j ❑ n ❑ ❑ a <br /> Go ❑ ❑ ❑ ❑ o u <br /> ❑ ❑ ❑ kJ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ <br /> ❑ 6 u o ❑ ❑ ❑ Q <br /> ❑ ❑ ❑ ❑ r� ❑ o <br /> ❑ ❑ o ❑ ❑ ❑ ❑ ❑ <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> Testin sUlution taken with us to use at nest test <br /> Inspector's Signaturc;�- - �" <br /> Date; <br /> b:I'd 22t7269t7:0l 96,LIti2SG0 99NHI-1dW03 190:WONJ 6t,-:OI SI02-6I-990 <br />